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PubMed2000

GPs' referral to mental health care during the past 25 years.

Previous research has shown that mental disorder in the community has remained fairly constant over the past 30 years. As a result there has been a shift in mental health care from primary care to specialised mental health care. This shift should be visible in higher referral figures from general practice. In this longitudinal analysis of mental health referrals (1971 to 1997), the authors aimed to answer whether these higher referral rates have occurred, whether there are increases in referral for specific groups, and whether the referral pattern has changed. The results demonstrate an increase in referral rate with a factor of 4.5. It is concluded that we are witnessing a pull from mental health care together with a push from general practice, thus reinforcing each other.

Adolescent↗
PubMed1980

Health stability and change: a study of urban black youth.

Personal interviews were conducted with a representative sample of 536 urban Black youth at two points in their life cycle: first when they were adolescents, aged 12--17, and six to eight years later when they were young adults, aged 18--23. A total of 47 health problems for males, 48 for females, were inquired about each time. Longitudinal analysis was performed to determine the extent of change, the direction of change, and the health problems most subject to change. The number of health problems increased for both sexes, but the increase was significantly greater among males than females. Male and female morbidity count, thus, became nearly equivalent in young adulthood whereas, in adolescence, young women's had exceeded men's. More detailed age analysis revealed that the greatest increase in male's health problems occurred two years behind that for women: for men, between ages 17 and 18; for women between ages 15 and 16. With but few exceptions, the same health problems which dominated in adolescence continued to be most prevalent in young adulthood. Population prevalence rates, however, understate the considerable degree of shift or turnover in individual cases reporting health problems as well as in general health status as measured by the total number of those problems.

Adolescent↗
PubMed1995

Natural killer cell activity in patients with invasive cervical carcinoma: importance of a longitudinal evaluation in follow-up.

OBJECTIVE: To analyze longitudinally the basal natural killer cell activity in patients with invasive cervical carcinoma, the natural cytotoxicity was related to the most important known prognostic factors, and evaluated with respect to the clinical outcome of cervical disease. MATERIALS AND METHODS: Forty-six patients with histologically proven invasive cervical carcinoma treated and followed at the Institute of Gynecology and Obstetrics, Ancona University, Salesi Hospital, were consecutively recruited from 1989 to 1992 and included into the study. For immunologic investigation, natural killer cell activity and peripheral blood T-lymphocyte subsets were tested before primary treatment and during the follow-up period, every 6 months. Natural killer activity was determined by target cell retention of the fluorescent dye carboxyfluorescein diacetate; the K 562 cell line was used as target cells. RESULTS: A significant inverse relationship was observed between natural killer activity and disease stage (p = 0.001); patients with stage IV disease had the lowest level of natural cytotoxicity. The reduction of natural cytotoxicity was not accompanied by any alteration of lymphocyte distribution. The longitudinal analysis showed an increase of natural killer activity after surgical removal of the tumor, persisting during the follow-up, but all the 9 patients who recurred showed, at the time of disease recurrence, a significant decrease of their natural cytotoxic potential. CONCLUSION: Natural killer cell activity seems to be a functional index of immune status, significantly related to the stage and the clinical outcome of disease.

Adenocarcinoma↗
PubMed1999

Persistence and clinical outcome of hepatitis G virus infection in pediatric bone marrow transplant recipients and children treated for hematological malignancy.

The natural course and the clinical significance of hepatitis G virus (HGV) infection were investigated in 106 pediatric patients who received chemotherapy for hematological malignancy or underwent bone marrow transplantation (BMT) using HGV-RNA and antibodies to the HGV-E2 protein (anti-E2). HGV markers were detected in 21 patients (19.8%; HGV-RNA in 19 and anti-E2 in 2). Longitudinal analysis of these HGV-infected patients showed that 1 had anti-E2 before the initial blood transfusion, 14 had persistent viremia, and 6 became clear of circulating HGV-RNA after completion of therapy, although 5 of the 6 HGV-cleared patients never developed anti-E2. Reactivation of HGV infection during chemotherapy was observed in two anti-E2-positive, HGV-RNA-negative patients; the reappearance of the same HGV strain was confirmed by phylogenetic analysis. Among BMT survivors without other known causes of liver dysfunction, HGV-RNA-positive patients had a higher peak serum alanine amino transferase (ALT) value than negative patients. Contrary to previous reports, immunosuppressed patients can apparently recover from HGV infection without detectable anti-E2 and some patients who supposedly recovered from HGV infection can nonetheless suffer exacerbation when subsequently immunosuppressed.

Adolescent↗
PubMed1995

Early intervention for low birthweight, premature infants: participation and intellectual development.

The Infant Health and Development Program was an eight-site randomized controlled trial of comprehensive early intervention for low birthweight, premature infants during the first 3 years of life in which intellectual development was an outcome of major importance. At 24 and 36 months, but not at 12 months, higher Mental Development Index and IQ were associated with higher levels of participation in the intervention. In a longitudinal analysis of these data, we found that the intellectual development of children in the intervention group was associated with each of the three intervention modalities (the number of home visits received, days attended at child centers, and the number of parent meetings attended) but not with children's background characteristics (i.e., maternal education, birthweight). We suggest that these findings represent a dose-response relation between intervention and outcome.

Brain Damage, Chronic↗
PubMed2005

Dynamics of HPV16 DNA load reflect the natural history of cervical HPV-associated lesions.

BACKGROUND: High burden of high risk human papillomavirus (HR HPV) has been shown to be predictive for the development of high grade cervical lesions and invasive cancers. However, low viral load cannot inevitably exclude progression towards cervical diseases. Moreover, few studies addressed whether viral load could predict infection clearance. OBJECTIVES: We carried out a retrospective study to analyze the variations of HPV16 load over time as a predictive marker of clinical outcome. STUDY DESIGN: The population consisted of 38 women who were found HR HPV positive by HCII test at study entry. Among them, 13 had developed a CIN2/3 (cases) and 25 had a negative HCII test and a normal cytology (controls) at study exit. The HPV16 DNA loads were quantified in 132 longitudinal cervical samples using quantitative real-time PCR. RESULTS: At study entry, the median of HPV16 load was not statistically different between controls and cases. However, when using a cut-off value of 200 copies/10(3) cells, the rate of cumulative incidence of CIN2/3 at 18 months increased from 14% in women with a load 200 copies/10(3) cells. The longitudinal analysis performed on follow-up samples showed that in cases the progression to CIN2/3 was linked to HPV16 burden increasing over time, whereas in controls a decrease of at least 1 log HPV16 DNA load was observed over>or=2 time points. CONCLUSIONS: These results show that kinetics of HPV load, rather than a single HPV detection, might be more reliable to estimate whether a HPV infection will progress or be cleared.

Adolescent↗
PubMed2006

Prevalence and incidence of respiratory symptoms in relation to indoor dampness: the RHINE study.

BACKGROUND: An association between indoor dampness and respiratory symptoms has been reported, but dampness as a risk factor for the onset or remission of respiratory symptoms and asthma is not well documented. METHOD: This follow up study included 16 190 subjects from Iceland, Norway, Sweden, Denmark, and Estonia who had participated in the European Community Respiratory Health Survey (ECRHS I). Eight years later the same subjects answered a postal questionnaire that included questions on respiratory symptoms and indicators of indoor dampness. RESULTS: Subjects living in damp housing (18%) had a significantly (p<0.001) higher prevalence of wheeze (19.1% v 26.0%), nocturnal breathlessness (4.4% v 8.4%), nocturnal cough (27.2% v 36.5%), productive cough (16.6% v 22.3%) and asthma (6.0% v 7.7%). These associations remained significant after adjusting for possible confounders. Indoor dampness was a risk factor for onset of respiratory symptoms but not for asthma onset in the longitudinal analysis (OR 1.13, 95% CI 0.92 to 1.40). Remission of nocturnal symptoms was less common in damp homes (OR 0.84, 95% CI 0.73 to 0.97). CONCLUSIONS: Subjects living in damp housing had a higher prevalence of respiratory symptoms and asthma. Onset of respiratory symptoms was more common and remission of nocturnal respiratory symptoms was less common in subjects living in damp housing.

Adult↗
PubMed1998

Comparison of GAD and ICA512/IA-2 antibodies at and after the onset of IDDM.

OBJECTIVE: Longitudinal changes in GAD antibody (Ab) and ICA512/IA-2 (ICA512) Ab were examined in relation to age at the onset of diabetes and autoimmunity against the thyroid gland. RESEARCH DESIGN AND METHODS: GADAb, ICA512Ab, and antithyroid autoantibody were examined at onset in 40 juvenile-onset IDDM patients (17 males, 23 females, age at onset 9.4 +/- 4.1 years, range 1.7-20). To assess the changes in antibody levels, 29 patients were followed up with sequential serum samples for up to 5 years. RESULTS: At onset, GADAb, ICA512Ab, and antithyroid autoantibody (thyroglobulinAb or thyroid peroxidaseAb) were found in 70, 58, and 25% of the 40 patients, respectively. Prepubertal patients (n = 21) had a significantly higher prevalence and index of ICA512Ab compared with pubertal patients (n = 19) (76 vs. 37%, P = 0.012, and 2.43 +/- 2.36 vs. 0.66 +/- 1.23, P = 0.011), while GADAb was more prevalent in pubertal patients (57 vs. 84%, P = 0.09). A longitudinal analysis of GADAb and ICA512Ab showed that GADAb levels declined more slowly than those of ICA512Ab (P = 0.008). Patients with continuous extremely high levels of GADAb also had high levels of antithyroid autoantibody. CONCLUSIONS: The measurement of ICA512Ab is useful in prepubertal patients, who often show rapid progression of the disease. The presence of autoimmunity against thyroid gland seems to influence the GADAb level but not the ICA512Ab level.

Adolescent↗
PubMed1984

Are pregnant teenagers still in rapid growth?

Longitudinal analysis of 1,601 teenage girls, followed up through two or three pregnancies, provided no evidence that the larger pregnancy weight gains observed in younger teenage mothers were attributable to rapid growth. These data were consistent with the time elapsed between menarche and the first pregnancy and refuted popular explanations for the higher pregnancy weight gains in early teenage pregnancy. Fluid retention and increased fluid volume, rather than additions to maternal body mass, were more likely explanations for the high weight gain of younger teenage mothers.

Adolescent↗
PubMed1989

Decline of blood haemoglobin in the aged: a longitudinal study of an urban Swedish population from age 70 to 81.

Blood haemoglobin (Hb) and related components were determined in a representative sample (n = 973, 449 men and 524 women) of a 70-year-old population, reinvestigated at age 75, 79 and 81. At age 81, 145 men and 259 women remained in the study. Longitudinal analysis demonstrated a significant decline in Hb concentration with advancing age, in the total study groups as well as in subsamples remaining after exclusions due to disease. The mean annual decline from age 70 to 81 in a subsample without definable disorders was in men 0.063 g/dl, in women 0.035 g/dl. There was a similar decline among subjects with high, intermediate or low Hb concentrations during the study. Only part of the observed intraindividual variations could be explained by factors other than age.

Aged↗
PubMed1992

The relationship between digit sucking and behaviour problems: a longitudinal study over 10 years.

Data from the Dunedin (New Zealand) Multidisciplinary Health and Development Study were used to examine continuity and discontinuity in digit sucking between 5 and 11 years. The data were also used to examine the relationship between digit sucking and behaviour problems at 5, 7, 9, 11 and 15 years. Cross-sectional analyses showed a relationship between digit sucking and behaviour problems at all ages, except 5 years. Longitudinal analysis by multiple regression showed that digit sucking at 5 and 7 years predicted behaviour problems at 7, 9 and 11 years. This effect was most apparent at 7 years. Children who sucked their digits at 11 years were more likely to have overjets of 6mm or more between their upper and lower dental arches. The behavioural and dental evidence suggest that it would be better for children to stop sucking their digits before they started school and acquired their permanent dentition.

Adolescent↗
PubMed2004

Suppression of longitudinal increase in CSF F2-isoprostanes in Alzheimer's disease.

We report the first longitudinal analysis of cerebrospinal fluid (CSF) F2-isoprostanes (IsoPs), quantitative in vivo biomarkers of lipid peroxidation, in patients with mild Alzheimer's disease (AD). CSF F2-IsoPs (i) were significantly increased in patients followed over one year, (ii) correlated with some clinical indices of dementia following correction for variation in ventricular enlargement, and (iii) were significantly lower in patients who used both alpha-tocopherol and vitamin C.

Aged↗
PubMed1987

Freshman and senior medical students' attitudes toward the elderly.

The authors' purpose in the present study was to examine attitudes toward the elderly among medical students and the impact of medical education on such attitudes. Questionnaires first used in a similar study in the 1960s were administered to freshman and senior medical students in 1981 and 1984 at one medical school. Comparison of these two groups indicated that the seniors viewed the elderly more positively than did the freshmen in certain areas, namely the productivity, social significance, and sexuality of the aged. To control for potentially confounding shifts in cultural values in society as a whole and in medical school selection variables, the two freshman groups were compared, and the two senior groups were compared. Results of these analyses indicated few, if any, differences between the freshman classes of 1981 and 1984 or between the senior classes of the same years. Finally, a longitudinal analysis was performed to contrast the attitudes of the students first sampled as freshmen in 1981 to their perceptions as seniors in 1984. Further, the results of the present study were compared with those of a similar study in the 1960s. Taken together, these results indicate that attitudes toward the elderly are becoming more favorable in society in general and in medical schools in particular and that the medical education process was responsible for the more favorable attitudes expressed by the senior medical students.

Adult↗
PubMed1999

Fat conversion of femoral marrow in glucocorticoid-treated patients: a cross-sectional and longitudinal study with magnetic resonance imaging.

OBJECTIVE: To study the changes in hematopoietic marrow in patients given glucocorticoid (steroid) therapy. METHODS: In a cross-sectional study, high-resolution T1-weighted magnetic resonance imaging (MRI) images of the proximal femur were obtained in an unselected series of 29 premenopausal female patients with systemic lupus erythematosus (SLE) and in a series of 29 age-matched healthy female subjects. In a longitudinal analysis, 2 MRI studies were performed 19 months apart in 11 patients with SLE (including 9 patients from the cross-sectional study who were evaluated before treatment) and in 7 patients with rheumatoid arthritis (RA). The percentage of fat marrow and the index of marrow conversion (IMC) were derived from the MRI images to estimate the degree of transformation of hematopoietic into fatty marrow in the area of the femoral neck. Values observed in the cross-sectional study and their changes over time were correlated with treatment data. RESULTS: The cross-sectional study performed in SLE patients indicated that their mean (+/- SD) percentage of fat marrow (48+/-36%) and IMC (82+/-12) were significantly more elevated than those in the healthy control subjects (18+/-16% and 75+/-6, respectively) (P<0.01). The magnitude of fat conversion correlated positively with the mean daily dose of oral prednisolone, and was higher in patients with ischemic bone lesions. The longitudinal study performed in SLE and RA patients revealed that IMC changes over time correlated positively with daily prednisolone intake (r = 0.71; P = 0.001), fat conversion occurring exclusively in patients receiving a mean prednisolone dose < or =7.5 mg/day. CONCLUSION: MRI indicates that fat conversion occurs in the proximal femur of steroid-treated patients. The magnitude of fat conversion correlates with steroid intake and is higher in patients with ischemic bone lesions.

Adolescent↗
PubMed2002

A longitudinal study of risk factors for otitis media in African American children.

OBJECTIVE: Otitis media with effusion (OME) is a common health care problem for children. The purpose of this study was to examine factors that place children at risk for OME such as age, type of child care, number of people in the household, and smoking in the household. METHODS: Eighty-six African American children, enrolled in center-based child care in infancy, entered the study at a mean age of 8.2 months and were followed prospectively until 48 months of age. Ear status was documented biweekly using pneumatic otoscopy and tympanometry. Data on risk factors were collected every 6 months. RESULTS: Results indicated that children had a marked decrease in the proportion of time with OME between 6 and 48 months. The rate of OME decline was faster in the first 2.5 years than in subsequent years. Children in center-based child care showed a slightly slower rate of decline than did children in non-center-based care. Longitudinal analysis indicated that the age of the child and the number of other children in the household were significant predictors of OME. For each additional child under 12 years of age in the home, there was a 2% increase in the proportion of time with OME. CONCLUSION: While attendance in group child care predicted a risk for OME, children's age and the number of other children in the household were still contributing risk factors for OME.

Black or African American↗
PubMed2005

Corneal asphericity and apical curvature in children: a cross-sectional and longitudinal evaluation.

PURPOSE: The contour of the human cornea is closely modeled by a conic section, which is fully described by asphericity (Q) and apical radius of curvature (r(o)). The relationship between corneal shape and other ocular dimensions in children, including anterior and vitreous chamber depths, axial length, and spherical equivalent refractive error, was investigated. METHODS: Corneal asphericity and r(o) were calculated by using corneal topography data on 643 children (72 myopes, 370 emmetropes, and 201 hyperopes), ages 6 to 15 years, who participated in the Orinda Longitudinal Study of Myopia (OLSM) during 1991. Measurements from a younger subset of these children, including 8 myopes, 92 emmetropes, and 75 hyperopes, ages 6 to 9 years in 1991, were compared to 1996 data for longitudinal analysis. RESULTS: Mean +/- SD Q of the 1991 study sample was -0.346 +/- 0.101, representing a prolate corneal shape. Almost all (99.7%) of the corneas examined were prolate. Corneal asphericity was less prolate among myopes than in emmetropes and hyperopes (P = 0.010). Less prolate corneas were related to deeper anterior chamber depths among emmetropes (r = 0.324, P < 0.0001) and hyperopes (r = 0.275, P < 0.0001), but not among myopes (r = 0.230, P = 0.0515). Flatter values of r(o) were related to longer vitreous chamber depth (r = 0.607, P < 0.0001) and axial length (r = 0.606, P < 0.0001) in all refractive error groups. Initial corneal shape was unrelated to change in refractive error over a 5-year period. CONCLUSIONS: Most corneas examined in this study were prolate in contour. Deeper anterior chamber depths were related to less prolate corneas among emmetropes and hyperopes, which is probably the result of mechanical influences on the peripheral cornea as the anterior chamber elongates during ocular growth. Longitudinal results suggest initial corneal shape is of little or no value in predicting refractive error progression.

Adolescent↗
PubMed1997

Quantity of cytomegalovirus viruria is a major risk factor for cytomegalovirus disease after renal transplantation.

Studies have shown that risk factors for human cytomegalovirus (HCMV) disease after renal transplant include primary infection (virus of donor origin infecting a non-immune individual), re-infection (virus of donor origin infecting a immune individual), and the detection of viraemia (as a marker of virus dissemination). We now report that viral load in the urine is also a significant factor in HCMV disease and is one of the main mechanisms underlying the risk associated with viraemia and donor serostatus. Longitudinal analysis of a group of 196 renal recipient identified 35 recipients who were PCR positive for HCMV in urine. Elevated viral loads were present in symptomatic patients, viraemic patients, and patients experiencing primary HCMV infection. Disease was associated with the peak quantity of virus present in the urine during the post-transplant period (P = 0.0001), with viraemia (P = 0.0003), and with transplantation of a seropositive donor (P = 0.03). Univariate logistic regression analysis showed that increases of 0.25 log10 in viral load were associated with a 179% increased risk of disease (odds ratio = 2.79; 95% C.I. 1.22-6.39; P = 0.02). This effect persisted in a multivariate logistic analysis when viraemia was incorporated (odds ratio = 2.77; 95% C.I. 1.07-7.18; P = 0.04). In contrast, the significant association between viraemia and disease observed in univariate analysis (odds ratio = 23.75; 95% C.I. 3.69-152.90; P = 0.0009) became marginally non-significant in multivariate analysis once viral load had been controlled for (odds ratio = 34.54; 95% C.I. 0.75-1599.00; P = 0.07). The computed probability of disease showed that a rapid transition occurred at viral loads between 10(5.7) and 10(6.5) genomes/ml urine in non-viraemic patients compared to viral loads between 10(5.0) and 10(5.7) genomes/ml urine in patients with concurrent viraemia. The implications of these findings for understanding HCMV pathogenesis, improving patient management, and optimising trials of antiviral treatment are discussed.

Adolescent↗
PubMed1996

Nature of decision-making in the terminally ill patient.

The increasing emphasis on the consumer's choice in health care treatment has contributed to the growing trend for decision-making to be shared between the patient and the health care team. If responsibility is to be shared, then it is important that health professionals identify the degree to which patients wish to participate in the decision-making process, in order that they can assist patients to achieve this goal. The seven patient case studies in this pilot study explored terminally ill patients' perceptions of their own participation in the decision-making process. A simple strategy, through the use of picture cards, established patients' actual and preferred forms of decision-making. These cards were presented to the patients at various stages of their illnesses, which permitted a longitudinal analysis of the decision-making process. Patients initially stated that they did not want much input into the decision-making process. In this study, however, as patients became more knowledgeable about their conditions, they desired greater input into the decision-making process. These findings also revealed that, although there was consistency between patients' preferred and actual forms of decision-making when they were initially admitted to hospital, discrepancies became apparent during the later phases of their illness. This emphasises the need for communication between all parties involved in health care decisions.

Adolescent↗